Healthcare Provider Details

I. General information

NPI: 1518353630
Provider Name (Legal Business Name): STEPHEN E. CRAIG PH.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 03/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503-1455
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-7207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007857
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: